Matthew O. Berger
WASHINGTON, Aug 23 2010 (IPS) – The stories of Dr. Ciro de Quadros work in eradicating smallpox read like the stuff of global health legend.
Working for the World Health Organisation in Ethiopia in the early 1970s, he and his team once walked for 26 days along the remote Sudanese border region to investigate the spread of an outbreak and vaccinate those who may have come in contact with the disease.
Accessibility and communications were very difficult, he says, adding that eradication efforts there took six years, including an interruption for the overthrow of emperor Haile Selassie in 1974.
He then moved on to Somalia where transmission was eventually interrupted in 1977 and the last case of smallpox was found and contained, making it the first infectious disease to be totally eradicated from the globe.
De Quadros was far from alone in the fight against the smallpox, a disease that had killed countless numbers of people dating back to at least 1000 BCE including about 50 million new cases each year as recently as the 1950s.
Dr. Walt Orenstein, for instance, had seen the last case in India s Uttar Pradesh state, a seven-month-old girl who died on May 16, 1975.
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He and de Quadros will join colleagues from that successful campaign for a symposium in Rio de Janeiro from Tuesday through Friday to commemorate the 30th anniversary of smallpox eradication.
The main topic will be how to apply the lessons learned from that fight to current global health challenges, including the eradication of other vaccine-preventable diseases.
This event is not simply a celebration of the anniversary. It s really an opportunity to bring people together who worked on smallpox and see what the lessons are, Orenstein told IPS. And not just smallpox people but people who have worked in other areas, too, to see what lessons can be applied to their work.
De Quadros has already applied some of those lessons as he helped to eradicate polio in the Western Hemisphere while head of the Pan American Health Organisation s immunisation programme. That ambitious goal was achieved in 1994.
Measles and rubella eradication efforts are also using some of the lessons taken from the smallpox campaigns, he says.
Among those lessons are the new methodologies that were developed to combat its spread, including the strategy of surveillance and containment.
When you found a patient, de Quadros explained by phone from Brazil, you would investigate where they got the disease, and that way you could trace the chain. In the meantime, you would vaccinate all the people you meet in that chain. So it was a very effective strategy.
Surveillance and containment was applied from day one in the Ethiopian eradication effort the first time it had been applied from the start and likely a reason why the campaign was so successful despite the logistical difficulties on the ground there.
But not all the methodologies are applicable to every infectious disease.
For instance, in the case of rotavirus the leading cause of severe diarrhoea and the dehydration it causes a vaccine already exists but the patients can continue to have diarrhoea due to other causes, says de Quadros, now executive vice president of the Sabin Vaccine Institute.
Still, he paints an optimistic picture for future eradication efforts.
The prospects are in some ways outstanding. Polio eradication is now almost complete I believe if polio is eradicated, the world will bite the bullet and eradicate measles, de Quadros says, adding that the last case of measles in the Western Hemisphere was eight years ago while that of rubella was two years.
And all this is possible because smallpox showed the way, he adds. That means it can be done if we apply the right lessons.
Orenstein breaks these lessons into three points. First, the importance of political will. Government support was critical to combating smallpox, he said. People will follow if there is good leadership.
Second, innovation was and is needed both in terms of technology and strategies. The bifurcated needle, for instance, made smallpox vaccinations much faster, easier and cheaper and strategy innovations like surveillance and containment were critical to finally reversing the course of a disease that had plagued humans for thousands of years.
Third, says Orenstein, adequate resources are needed to be able to pay workers and buy vaccines, among other needs.
De Quadros adds that you need clear objectives and you need good strategies, but that strategy cannot be set in stone.
Those are the key lessons which we are applying to polio, says Orenstein, currently the deputy director for vaccine- preventable diseases at the Bill Melinda Gates Foundation, where he is working at winning the final few battles against polio, among other goals. Polio cases have dropped 99 percent since 1988 and remain in only Afghanistan, India, Nigeria and Pakistan.
They are also funding research into developing new vaccination technology, introducing vaccines available in the industrialised world to the third world including those for pneumococcal infections like pneumonia and rotavirus as well as efforts to create new vaccines for diseases like HIV.
This week s symposium should provide an opportunity to review the wealth of disease and vaccine knowledge accumulated over 30 years ago and in the decades since. All of us who worked on smallpox have now had substantial experience afterward and that has helped put the lessons from smallpox in perspective, notes Orenstein.
We are all very excited about this meeting, says de Quadros. It s the first time we are going to look at what was done and how these lessons are being applied to other challenges.
